Varied Symptomatology and Computed Tomography Analysis of Coral Reef Aorta: Exploring the Symptom-location Relationship.

Abstract

Purpose: To describe the clinical manifestations of coral reef aorta (CRA), determine the common locations of CRA on CT, and assess the relationship between lesion location and clinical symptoms.

Materials and methods: Keyword detection in CT reports at a single institution between 2008 and 2021 revealed 27 patients with CRA. Aortic segments were grouped by relation to the aortic branches. Patient's characteristics, cardiovascular risk factors, treatments, and outcomes were collected from the medical record.

Results: Median age was 63.7 (IQR: 58.1-70.6). Of the total, 77.8% (21/27) were females. The most common risk factors were hypertension (23/27) and smoking (24/27). Diabetes was present in 4/27, 14.8%. All CRAs were at the level of the celiac trunk or distal. The most common symptom was claudication (9/27), but 8/27 were asymptomatic. Approximately 74% of the CRAs were superior to the inferior mesenteric artery (20/27).Claudication was significantly more common in patients with CRA inferior to the inferior renal artery (iRA, 8/13, 61.5%) than those with the CRA superior to the iRA (including iRA) (2/14, 14.3%; P = 0.018). Pulmonary edema was seen in 2/5 patients with CRA between the superior renal artery and iRA compared with none when the CRA was located in other segments (P = 0.043).

Conclusion: Nearly all patients with CRA had a history of hypertension and smoking, and the majority were female. The most common CRA segment was distal to the iRA, which was associated with claudication. The CRA involving the renal arteries was associated with recurring pulmonary edema.